Permit •
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 -00012
- • TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/09/2013
Parcel: 25111 CCO2300 •
i1 Jurisdiction: Tigard
Site address: 10385 SW CENTURY OAK DR
Project: Coffield Subdivision: SUMMERFIELD Lot: 20
Project Description: (1) tub /shower replacement and valve
Contractor: RAYBORN'S PLUMBING INC Owner: COFFIELD. WILLIAM H &
19990 SW CIPOLE RD FRANCES 0 TRS
TUALATIN, OR 97062 10385 SW CENTURY OAK DR
TIGARD, OR 97224
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES .
Quantity Description Date Amount
,1 ea Tub /Shower /Shower Pan 01/09/2013 $12.51
Specifics: 1 12% State Surcharge - 01/09/2013 $8.70
Plumbing
Type of Use SF 60 ea Minimum Fee Adjustment - 01/09/2013 $59.99
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
•
•
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: p / 7 Permittee Signature: I�1 vi -- O f woo.
� � (�- lIGGGttt///lll // ice.% u •-^ �1
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
-503 691 2328 Rayborns Plumbing 03:00:17 p.m. 01 -08 -2013 1 /2
Plumbin»t Permit A '\ y QED
Building Fixtures
City of Tigard 1 n (�1 o g 2013 Received Permit No.:
• 13125 SW Hall Blvd,Tigard.OR1�I7Z Date/By: (� � �( -00:21d--.
9^ spn Pip Other Permit No.:
I Phone: 503.639.4171 Fax: 503.51 1 1 Date/By: Inspection Line: 503.639. s ljf' u Date Ready/By: . Page 2 for
I. I'; .\ l ' I ' Internet: www.ti rd-or. M1 `' 504
88 wird V'J1V NotiiedlMdlrod: 71 Supplemental Information
TYP , • • WORK. • - . . • . FEE SCHEDULE -. • . .
❑ N construction ❑Demolition For spedal information use checklis
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑ Other New I- 2- family dwellings (includes 100 ft. for each utility connection)
• CATEGORY OF CONSTRUCTION • - SFR (1) bath I 312.70
1- and 2- family dwelling ❑ Commercial/industrial SFR(2) bath 437.78
El Accesso building SFR(3)bath 500.32
ry g ❑ Multi- family
Each additional bath/kitchen 25.02
El Master builder ❑ Other Fire sprinkler (_ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
S c S �1 / „ K t , u t - 1 Catch basin or area drain 1 8.76
Job site address:
City /StatelZlP: O C � q l- ) ��u k Da � Y
Drywell, leach line, or trench drain 18.76
�3 u'f 0 O Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear R: _ ) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Fixture or Item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
1 Clothes washer 25.02
Oft Flu/ e 17 s�) clef) t.....) e � ) a \ 101. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER , ❑ TENANT Expansion tank 12.51
Name:
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
LICANT ❑ CONTACT PERSON Intereeptorigrease trap 25.02
Business name: �JO , �S ��, �� Prier Medical gas (value: $ ` ) Page 2
Primer 12.51
Contact name: /V M A u �`,. Roof drain (commercial) 12.51
Address: t C�(� (1 �•w C ` , e R a Sinkbasinilavatory 25.02
City/State /ZlP l k 0 .1 r ; . , f ( t 1 p 6 Z- Solar units (potable water) 62.54 1
� _ t.
Phone: ( 6a.113C'I
::)Fax: : (5. 3 l 6 D 1 _ 3 Tub shawer /shower pan 12.51
Urinal / 25.02
Email: /fC�e ��GlVt t s a c O � ..
Water closet 25.02
(?ONTRACTOR
Business name: %'y
t3 �
Water heater 37.52 l
y �/ V( S �"1, e � i M-.- Water piping/DWV 56.29
Address: /?qqo 5W C pole. lrrr Other. 25.02
City/State/ZIP. 1v 01 Q1'1 CC � - Subtotal
Phone:
Minimum permit fee: 572.50
(to3) (co ( co -yi Fax: ) 441 - a3ag p
Plan review t25% of permit fee)
CCB Lie.: eg 7$t; 1 . umbin ic. no.:`y1_ P
State surcharge (12% of permit fee)
Authorized signature: �� �r . - TOTAL PERMIT FEE d
Print name: + Date: This permit application expires if a permit Ix not obtained Mild O days
ays
r 8 - / 3 after It has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I Building Prnnits .PLMll- PermtApp Inc 10.0100 440- 40I6T(11.O2.COMWFB)